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. 2022 Nov 28;15(22):2253-2265.
doi: 10.1016/j.jcin.2022.09.007.

Platelet Reactivity and Clinical Outcomes After Drug-Eluting Stent Implantation: Results From the PTRG-DES Consortium

Seung-Jun Lee  1 , Jung-Joon Cha  2 , Young-Hoon Jeong  3 , Sung-Jin Hong  1 , Chul-Min Ahn  1 , Jung-Sun Kim  1 , Young-Guk Ko  1 , Donghoon Choi  1 , Myeong-Ki Hong  1 , Yangsoo Jang  4 , Hyung Joon Joo  2 , Kiyuk Chang  5 , Yongwhi Park  6 , Young Bin Song  7 , Sung Gyun Ahn  8 , Jung-Won Suh  9 , Sang Yup Lee  10 , Jung Rae Cho  11 , Ae-Young Her  12 , Hyo-Soo Kim  13 , Moo Hyun Kim  14 , Eun-Seok Shin  15 , Do-Sun Lim  16 , Byeong-Keuk Kim  17 ; PTRG Investigators
Affiliations
Free article

Platelet Reactivity and Clinical Outcomes After Drug-Eluting Stent Implantation: Results From the PTRG-DES Consortium

Seung-Jun Lee et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: The long-term prognostic implication of platelet reactivity after percutaneous coronary intervention (PCI) is not clearly known.

Objectives: The impacts of platelet reactivity from the PTRG-DES consortium were assessed.

Methods: The primary endpoint was the major adverse cardiac and cerebrovascular events (MACCE) including all-cause death, myocardial infarction, stent thrombosis, or stroke. Key secondary endpoints were all-cause mortality, major bleeding, and net adverse clinical events (NACE), including MACCE and bleeding.

Results: Between 2003 and 2018, a total of 11,714 patients were enrolled and grouped into tertiles according to P2Y12 reaction units (PRUs): high PRUs (≥253), intermediate PRUs (188-252), and low PRUs (<188). The Kaplan-Meier (KM) estimates of the primary outcome were significantly different across the groups; the high-PRU group showed the highest MACCE rate at 5 years (12.9%, 11.1%, and 7.0% in high-, intermediate-, and low-PRU groups, respectively; P < 0.001), as well as at 1 year (P < 0.001). The high-PRU group had the greatest KM estimates of all-cause death (8.2%, 5.9%, and 3.7%, respectively; P < 0.001) at 5 years without significant differences of major bleeding, and resultant of a higher KM estimates of NACE (15.7%, 13.6%, and 9.7%, respectively; P < 0.001). A PRU ≥252, the best cutoff value, was strongly related to MACCE (HR: 1.39; 95% CI: 1.11-1.74; P = 0.003) and all-cause death at 5 years after PCI (HR: 1.42; 95% CI: 1.04-1.94; P = 0.026). The optimal cutoff value of aspirin reaction units predicting the MACCE occurrence was ≥414 and was significantly associated with 5-year MACCE occurrence or all-cause death (P < 0.001).

Conclusions: In this large-scale cohort, high PRU was significantly associated with occurrence of MACCE, all-death death, and NACE at 5 years, as well as 1 year after PCI. (PTRG-DES Consortium [PTRG]; NCT04734028).

Keywords: drug-eluting stent(s); percutaneous coronary intervention; platelet function tests; stent thrombosis.

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Conflict of interest statement

Funding Support and Author Disclosures The study was designed by the principal investigator and executive committee and was sponsored by the Korean Society of Intervention Cardiology. The funder had no role in study design, data collection, analyses, data interpretation, or preparing the manuscript. Dr Jeong has received honoraria for lectures from AstraZeneca, Daiichi-Sankyo, Sanofi, Han-mi Pharmaceuticals, and Yuhan Pharmaceuticals; and has received research grants or support from Yuhan Pharmaceuticals and U&I Corporation. Dr Joo has received honoraria for lectures from AstraZeneca, Han-mi Pharmaceuticals, Samjin, Dong-A, HK inno.N Pharmaceuticals, and DIO Medical. Dr Song has received honoraria for lectures from AstraZeneca, Daiichi-Sankyo, Sanofi, Bayer Korea, and Samjin Pharmaceutical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

  • Platelet Reactivity Testing: East Meets West.
    Stone GW, Camaj A. Stone GW, et al. JACC Cardiovasc Interv. 2022 Nov 28;15(22):2266-2269. doi: 10.1016/j.jcin.2022.09.046. JACC Cardiovasc Interv. 2022. PMID: 36423969 No abstract available.

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